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NRSG 421 > Week 1 - Oxygenation > Flashcards

Week 1 - Oxygenation Flashcards

1
Q

What are the treatments for acidosis?

A
  • NaHCO3 PO/IV
  • polystyrene sulfonate
  • glucose and insulin
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2
Q

in regards to the treatment of acidosis, what cautions do you need to take into consideration for NaHCO3?

A
  • renal impairment
  • CV disease
  • hypocalcemia
  • alkalosis
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3
Q

in regards to the treatment of acidosis, what cautions do you need to take into consideration for polystyrene sultanate?

A
  • abnormal bowel functions
  • SE
  • constipation
  • fecal impaction
  • intestinal necrosis
  • N/V
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4
Q

in regards to the treatment of acidosis, what cautions do you need to take into consideration for glucose and insulin?

A

conditions/ current status

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5
Q

what are the S&S of acidosis?

A
  • CNS depression
  • hyperkalemia
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6
Q

what is the treatment for alkalosis?

A
  • ammonium chloride
  • KCl
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7
Q

in regards to the treatment of alkalosis, what cautions do you need to take into consideration for ammonium chloride?

A
  • liver disease
  • renal function
  • metabolic acidosis
  • Ca deficit
  • ammonium toxicity
  • vein irritation
  • rash
  • bradycardia
  • N/V
  • headache
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8
Q

what are the S&S of alkalosis?

A
  • CNS stimulation
  • hypokalemia
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9
Q

what conditions cause respiratory acidosis? why?

A
  • COPD
  • obesity
  • use of opioids

all cause hypoventilation that lead to CO2 retention

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10
Q

what conditions cause respiratory alkalosis? Why?

A
  • anxiety
  • pneumonia
  • PE

all increase the RR and decrease CO2

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11
Q

what causes metabolic acidosis?

A
  • DKA
  • aspirin
  • diarrhea
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12
Q

what conditions cause metabolic alkalosis? why?

A
  • emesis
  • NG suction
  • diuretics

all cause loss of acid (vomiting) or gain of a base

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13
Q

define COPD

A
  • systemic disease
  • largely manifesting as an airflow-obstructing respiratory disorder
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14
Q

what does COPD stand for?

A

Chronic Obstructive Pulmonary Disease

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15
Q

how can COPD manifest?

A
  • emphysema
  • asthma
  • bronchiectasis
  • cystic fibrosis
  • chronic bronchitis
  • AECOPD
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16
Q

in regards to the different ways COPD can manifest, describe emphysema

A

lung tissue destruction and abnormal permanent enlargement of lung acini

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17
Q

define acini

A

airspaces distal to terminal bronchioles

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18
Q

in regards to the different ways COPD can manifest, describe bronchiectasis

A
  • destruction and widening of large airways
  • results in hyper-secretion of mucus and recurrent infections
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19
Q

in regards to the different ways COPD can manifest, describe chronic bronchitis

A
  • productive cough for 3 months per year over 2 consecutive years
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20
Q

in regards to the different ways COPD can manifest, describe AECOPD

A

sustained changes (>48 hrs) in:
- dyspnea
- cough
- sputum production

require increased use of medications to manage

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21
Q

COPD normally occurs in who?

A
  • people 40 years or older with smoking history
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22
Q

what are the risk factors for COPD?

A
  • smoking
  • heredity
  • age
  • lung infections
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23
Q

the risk for COPD increases with what?

A

the number of pack-years and a history of more than 40 pack years

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24
Q

describe the pathophysiology of COPD

A
  • decreased elasticity of lungs
  • increased production of mucous/ inflammation in airways which block air flow
  • air becomes trapped during expiation
  • chronic stage results in barrel chest > makes it more difficult to breath
  • bull and blebs form > not effective in gas exchange/ lead to hypoxemia/ hypercapnia
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25
Q

what are the signs of COPD?

A
  • prolonged expiration
  • rapid/ shallow breathing
  • barrel chest
  • hoover’s sign
  • dyspnea
  • expiratory wheeze
  • fatigue/ lower exercise tolerance
  • chronic cough with sputum
  • pursed-lip breathing
  • muscle weakness/ wasting
  • tripod sitting position
  • neck SCM
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26
Q

in regards to the signs of COPD, describe prolonged expiration

A

lung tissue damage may cause decreased elastic recoil to push air out of lungs

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27
Q

in regards to the signs of COPD, describeHoover’s sign

A
  • occurs in end stage when diaphragm is ‘flat’ and continued inspiratory efforts further contracts the diaphragm/ pulls the lower chest wall inwards
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28
Q

in regards to the signs of COPD, describe dyspnea

A
  • caused by decreased lung expansion and airflow obstruction > causes lungs to work harder to breathe
  • manifests as SOB especially on exertion
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29
Q

in regards to the signs of COPD, describe fatigue/ lower exercise tolerance

A
  • airflow obstruction leads to decreased alveoli ventilation
  • causes decreased 02 in blood > decreases the perfusion of tissues in the body
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30
Q

in regards to the signs of COPD, describe pursed-lip breathing

A
  • occurs in end stage
  • airflow obstruction causes client to breathe out against mouth pressure
  • forcing airways to widen
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31
Q

in regards to the signs of COPD, describe muscle weakness/ wasting

A
  • occurs in end stage
  • airflow obstruction causes chronic fatigue
  • leads to deconditioning
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32
Q

in regards to the signs of COPD, describe tripod sitting position

A
  • occurs in end-stage
  • airflow obstruction causes pt to breathe with accessory muscles and diaphragm to improve airflow
  • uses pectoral muscles to aid breathing
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33
Q

in regards to the signs of COPD, describe neck SCM

A
  • scalene muscle contraction
  • use of accessory muscles
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34
Q

what symptoms may the patient report for COPD?

A
  • muscle weakness
  • morning cough
  • increased production of mucous/ sputum
  • breathlessness with exertion
  • fatigue
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35
Q

what diagnostics are used for COPD?

A
  • spirometry
  • ABGs
  • CXR
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36
Q

in regards to the diagnostics for COPD describe spirometry

A

measures lung volume, capacities, the rate of flow, and gas exchange

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37
Q

what is included in primary assessments?

A
  • ABCDE
  • find and correct all life threatening conditions
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38
Q

what is included in secondary interventions?

A
  • FGHI
  • explore medical conditions
39
Q

what does FGHI stand for

A

F - full VS
G - give comfort
H - history & HTT
I - inspect posterior

40
Q

what achronym do you use in trauma situations?

A

AMPLE

41
Q

what does AMPLE stand for?

A

A - allergies
M - medications
P - past medical history
L - last meal
E - events

42
Q

what are 3 priority teaching points for COPD?

A
  • prevention
  • manage
  • action plan
43
Q

in regards to the 3 priority teaching points for COPD what is included in prevention?

A
  • vaccinations
  • quit smoking
  • avoid triggers
44
Q

in regards to the 3 priority teaching points for COPD what is included in mangement?

A
  • take meds as ordered
  • eat healthy
  • exercise as tolerated
45
Q

in regards to the 3 priority teaching points for COPD what is included in action plan?

A
  • exacerbation
  • infection
  • anxiety
46
Q

describe hypoxic drive

A
  • live in constant hypercapnia with constant CO2
  • giving long term O2 can make symptoms worse/ cause them to move into resp. arrest
  • chronic state of hypercapnia/ resp. acidosis leads to hypoxic drive and ran off of low O2
47
Q

what medications would you expect a person with COPD to have?

A
  • albuterol
  • methylprednisolone
  • prednisone
  • moxifloxacin
48
Q

describe albuterol

A
  • rescue inhaler
  • used for exacerbations
  • bronchodilator
49
Q

describe methylprednisolone

A
  • long acting
  • daily use
  • can take IV, IM, PO
50
Q

what is the preferred method of giving prednisone? can you stop it abruptly?

A
  • oral route preferred
  • needs to be weened off
51
Q

when is moxifloxacin used? what is it?

A
  • antibiotic
  • bacterial infections
  • used for people with penicillin allergy
  • moderate AECOPD
52
Q

in regards to V/Q mismatch, what does V stand for?

A
  • ventilation
  • ability of lungs to inhale/ exhale or ventilate
53
Q

in regards to V/Q mismatch, what does Q stand for?

A
  • perfusion
54
Q

what does V/Q mismatch mean?

A
  • mismatch between 2 lungs
  • PE decreases perfusion and the BV are blocked = less circulation/ perfusion
55
Q

what can V/Q mismatch cause?

A
  • lack of perfusion to rest of body tissue
  • dead space > oxygen not able to reach part of lung
56
Q

what are some clinical manifestations the nurse might see for a PE?

A
  • sudden onset
  • confusion
  • SOB
  • chest pain
  • tachycardia
  • increased WOB
  • cough c bloody secretions
  • cyanosis
  • fainting
  • anxiety
  • hypotension
57
Q

what are signs and symptoms of a DVT?

A
  • pleuritic chest pain
  • dyspnea
  • tachycardia
  • tachypnea
  • hypoxemia
  • cough
58
Q

why can a DVT not cause a stroke?

A

clot would have to move through right side of heart and then into lungs > would get caught in one of those organs and would not be able to make it to the brain

59
Q

what are some risk factors for a PE?

A
  • smoking
  • cancer
  • chemotherapy
  • sedentary lifestyle
  • trauma
  • surgery
  • hypercoagulability
  • estrogen
  • obesity
  • polycythemia
60
Q

what cause a PE?

A

DVT in arm or leg

61
Q

what are some risk factors/ causes of a stroke?

A
  • PICC
  • A. Fib
62
Q

why does estrogen put someone at an increased risk for a PE?

A

increases fibrin formation

63
Q

describe pneumonia

A

lung infection due to exposure to fungi, bacteria or virus

64
Q

what does pneumonia cause?

A

fluid build up that prevents proper lung expansion and oxygen to go into body

65
Q

what is pulmonary shunting?

A
  • fluid in alveoli that prevents oxygen from reaching underlying blood vessel
  • prevents gas exchange
  • decreased O2, increased CO2
66
Q

what are 3 serious complications of pneumonia?

A
  • ARDS
  • abscess
  • sepsis and shock
67
Q

pneumonia can cause inflammation which could result in stiff lungs and decreased compliance. What else can it lead to?

A
  • endocarditis
  • pericarditis
  • meningitis
  • bacteremia
68
Q

define endocarditis

A

inflammation of the inner lining of the heart’s chambers/ valves

69
Q

define pericarditis

A

swelling/ irritation of tissue surrounding heart

70
Q

define meningitis

A

inflammation of the tissues surrounding the brain and spinal cord

71
Q

define bacteremia

A

presence of bacteria in bloodstream

72
Q

what acronym do we use to remember the other complications of pneumonia ?

A

SLAP HER

73
Q

what does the SLAP HER acronym stand for when talking about other complications of pneumonia ?

A

S - sepsis
L - lung abscess
A - ARDS
P - parapneumonic effusion

H - hypotension
E - empyema/ effusion
R - respiratory/ renal failure

74
Q

what are early signs of respiratory failure?

A
  • tachycardia
  • tachypnea
  • restlessness
  • confusion
75
Q

what are late signs of respiratory failure?

A
  • altered LOC
  • dysrhythmia
  • hypotension
  • cyanosis
  • ileus
  • N/V
  • ileus
  • N/V
  • decreased urinary output
  • renal failure
76
Q

what are complications of an abscess?

A
  • fistula
  • spread
  • bleeding
  • empyema
77
Q

what are the signs someone has an abscess?

A
  • bad breath
  • fever >38.3
  • chest pain
  • SOB
  • night sweats
78
Q

how can pneumonia result in sepsis/ shock?

A

bacteria enter blood stream and body is in inflammatory hyperdrive

79
Q

when screening a pt for sepsis, what are the things you are looking for FIRST?

A

have 2 of the following:
- HR > 90/min
- RR > 20/min
- temp > or = to 38 degrees or <36
- altered mental status/ GCS change
- WBC > 12.0 or < 4.0x10/L

80
Q

when screening a pt for sepsis, after determining they have 2 signs what are the things you are looking for SECOND?

A

confirmed/ suspected source of infection OR:
- looks unwell
- 65+ yrs old
- recent surgery
- immunocompromised
- chronic illness

81
Q

when screening a pt for sepsis, after you confirmed or figured out the pt has an infection or one of the other items what do you looking at next?

A
  • SBP < 90 mmHg
  • MAP < 65 mmHg
82
Q

what are key interventions you could do for a patient with sepsis?

A
  • blood cultures before abx
  • abx w/in 3hrs
  • balance crystalloid
  • measure lactate within 3 hrs and repeat in 2-4hrs if elevated
  • norepinephrine if hypotensive after bolus
  • with significant ongoing vasopressor consider IV hydrocortisone
83
Q

what would be some examples of nursing interventions you could apply for a client with COPD, pneumonia or PE?

A
  • reposition
  • breathing exercises
  • O2 therapy
  • hydration
  • medication
84
Q

what medications could you give to a client with COPD, pneumonia or PE?

A
  • bronchodilators
  • corticosteroids
  • antibiotics
  • anti-mucolytics
  • vaccinations
  • antipyretics
  • analgesics
  • anticoagulants
  • diuretics
  • anti anxiety
85
Q

what are some medications we may want to be cautious with providing for a client with reduced oxygenation?

A
  • narcotics
  • benzodiazepines
  • barbiturates
  • cough suppressants
86
Q

a client with reduced O2 of unknown cause. What are some diagnostics to find a respiratory cause or to rule out other causes?

A
  • labs
  • diagnostics
  • invasive
  • cultures
  • others
87
Q

when determining or trying to rule out cause for a pt with reduced oxygenation what labs would you be assessing?

A
  • troponin
  • BNP
  • ABG
  • CBC
  • electrolytes
  • renal panel
  • INR/ PTT
  • CRP
88
Q

when determining or trying to rule out cause for a pt with reduced oxygenation what diagnostics would you be assessing?

A
  • CXR
  • CT
  • CT with contrast
  • VQ scan
  • MRI
  • ECG
89
Q

when determining or trying to rule out cause for a pt with reduced oxygenation what invasive tests might be ordered?

A
  • bronchoscopy
  • thoracentesis
90
Q

when determining or trying to rule out cause for a pt with reduced oxygenation what cultures would you collect?

A
  • NP swab
  • sputum C&S
91
Q

when determining or trying to rule out cause for a pt with reduced oxygenation what other things might be done?

A
  • VS
  • assessment
  • PFT
  • FEV
  • FVC
  • peak flow
92
Q

what does stridor indicate?

A
  • trachea blocked
93
Q

what does bronchi indicate?

A
  • fluid in bronchi/ trachea
94
Q

where does a pleural effusion happen?

A
  • in the all of the lungs
  • can use a chest tube for this

NRSG 421 (6 decks)

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